Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-09T00:17:01.256Z Has data issue: false hasContentIssue false
  • English
  • Français

HPV vaccine status and sexual behavior among young sexually-active women in the US: evidence from the National Health and Nutrition Examination Survey, 2007–2014

Published online by Cambridge University Press:  21 May 2019

Andrew J. Leidner Open the ORCID record for Andrew J. Leidner [Opens in a new window] ,
Harrell W. Chesson  and
Makram Talih
Andrew J. Leidner*
Affiliation:
Health Economist/Berry Technology Solutions, Federal contractor for Immunization Services Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS A-19, Atlanta, GA30333, USA
Harrell W. Chesson
Affiliation:
Division of STD Prevention, National Center HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA30333, USA
Makram Talih
Affiliation:
University of Porto Institute of Public Health, Rua das Taipas 135, 4050-600Porto, Portugal
*
*Correspondence to: aleidner@cdc.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Concern has been expressed that human papillomavirus (HPV) vaccination programs might promote risky sexual behavior through mechanisms such as risk compensation, behavioral disinhibition, or perceived endorsement of sexual activity. This study assesses whether HPV vaccination status is associated with any differences in selected sexual behaviors among young sexually-active women in the US. Our dataset includes young, adult female respondents from questionnaire data collected in the National Center for Health Statistics' National Health and Nutrition Examination Survey from 2007 to 2014. The empirical approach implements a doubly robust estimation procedure, based on inverse probability of treatment weighting. For robustness, we implement several specifications for the propensity model and the outcomes model. We find no consistent association between HPV vaccination and condom usage or frequency of sex. Specifically, we find no evidence that HPV vaccination is associated with condom usage or with whether a person had sex more than 52 or more than 104 times per year. We find inconsistent evidence that HPV vaccination is associated with a person having sex more than 12 times per year. As in previous research, HPV vaccination does not appear to have a substantive effect on sexual behavior among young sexually-active women in the US.

Keywords

Condom usagefrequency of sexhealth riskHPV vaccinerisk perceptionsexual behavior

JEL classification

I10: General I12: Health Behavior D81: Criteria for Decision-Making under Risk and Uncertainty D80: General D83: Search • Learning • Information and Knowledge • Communication • Belief • Unawareness
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 4 , October 2020 , pp. 477 - 495
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahrens, KA, Haley, BA, Rossen, LM, Lloyd, PC and Aoki, Y (2016) Housing assistance and blood lead levels: children in the United States, 2005–2012. American Journal of Public Health 106, 2049–2056.CrossRefGoogle ScholarPubMed
Bednarczyk, RA, Davis, R, Ault, K, Orenstein, W and Omer, SB (2012) Sexual activity–related outcomes after human papillomavirus vaccination of 11-to 12-year-olds. Pediatrics 130, 798–805.CrossRefGoogle ScholarPubMed
Brody, JE (2007) HPV vaccine: few risks, many benefits. New York Times, 15.Google Scholar
Brown, DS, Reed Johnson, F, Poulos, C and Messonnier, ML (2010) Mothers' preferences and willingness to pay for vaccinating daughters against human papillomavirus. Vaccine 28, 1702–1708.CrossRefGoogle ScholarPubMed
Brown, DS, Poulos, C, Reed Johnson, F, Chamiec-Case, L and Messonnier, ML (2014) Adolescent girls' preferences for HPV vaccines: a discrete choice experiment. In Preference Measurement in Health (Advances in Health Economics and Health Services Research, Volume 24). Bingly, UK: Emerald Group Publishing Limited, pp. 93–121.Google Scholar
Cassell, MM, Halperin, DT, Shelton, JD and Stanton, D (2006) Risk compensation: the Achilles' heel of innovations in HIV prevention. BMJ 332, 605–607.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2015) National Health and Nutrition Examination Survey Data, U.S. Department of Health and Human Services, Editor. Hyattsville, MD.Google Scholar
Cheng, NF, Han, PZ and Gansky, SA (2008) Methods and software for estimating health disparities: the case of children's oral health. American Journal of Epidemiology 168, 906–914.CrossRefGoogle ScholarPubMed
Chesson, HW and Gift, TL (2008) Decreases in AIDS mortality and increases in primary and secondary syphilis in men who have sex with men in the United States. JAIDS Journal of Acquired Immune Deficiency Syndromes 47, 263–264.Google ScholarPubMed
Chesson, HW, Ekwueme, DU, Saraiya, M and Markowitz, LE (2008) Cost-effectiveness of human papillomavirus vaccination in the United States. Emerging Infectious Diseases 14, 244–251.CrossRefGoogle ScholarPubMed
Crump, RK, Joseph Hotz, V, Imbens, GW and Mitnik, OA (2009) Dealing with limited overlap in estimation of average treatment effects. Biometrika 96, 187–199.CrossRefGoogle Scholar
Deb, S, Austin, PC, Tu, JV, Ko, DT, David Mazer, C, Kiss, A and Fremes, SE (2016) A review of propensity-score methods and their use in cardiovascular research. Canadian Journal of Cardiology 32, 259–265.CrossRefGoogle ScholarPubMed
Denny-Smith, T, Bairan, A and Page, MC (2006) A survey of female nursing students' knowledge, health beliefs, perceptions of risk, and risk behaviors regarding human papillomavirus and cervical cancer. Journal of the American Academy of Nurse Practitioners 18, 62–69.CrossRefGoogle ScholarPubMed
DuGoff, EH, Schuler, M and Stuart, EA (2014) Generalizing observational study results: applying propensity score methods to complex surveys. Health Services Research 49, 284–303.CrossRefGoogle ScholarPubMed
Food and Drug Administration (2006) June 8, 2006 Approval Letter - Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant. [cited 2015 12/18/2015]; Available from: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm111283.htm.Google Scholar
Food and Drug Administration (2009) October 16, 2009. Approval Letter - Cervarix. [cited 2015 12/18/2015]; Available from: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm186959.htm.Google Scholar
Food and Drug Administration (2014) December 10, 2014 Approval Letter - GARDASIL 9. Available from: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm426520.htm.Google Scholar
Freed, GL, Clark, SJ, Butchart, AT, Singer, DC and Davis, MM (2010) Parental vaccine safety concerns in 2009. Pediatrics 125, 654–659.CrossRefGoogle ScholarPubMed
Fujii, T, Yamada, S, Murotani, K, Kanda, M, Sugimoto, H, Nakao, A and Kodera, Y (2015) Inverse probability of treatment weighting analysis of upfront surgery versus neoadjuvant chemoradiotherapy followed by surgery for pancreatic adenocarcinoma with arterial abutment. Medicine 94, 1–9.CrossRefGoogle ScholarPubMed
Funk, MJ, Westreich, D, Wiesen, C, Stürmer, T, Alan Brookhart, M and Davidian, M (2011) Doubly robust estimation of causal effects. American Journal of Epidemiology 173, 761–767.CrossRefGoogle ScholarPubMed
Gallo, MF, Steiner, MJ, Warner, L, Hylton-Kong, T, Peter Figueroa, J, Hobbs, MM and Behets, FM (2007) Self-reported condom use is associated with reduced risk of chlamydia, gonorrhea, and trichomoniasis. Sexually Transmitted Diseases 34, 829–833.Google ScholarPubMed
Goldie, SJ, Kohli, M, Grima, D, Weinstein, MC, Wright, TC, Xavier Bosch, F and Franco, E (2004) Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. Journal of the National Cancer Institute 96, 604–615.CrossRefGoogle ScholarPubMed
Goossens, N, Hoshida, Y, Song, WM, Jung, M, Morel, P, Nakagawa, S, Zhang, B, Frossard, J-L, Spahr, L, Friedman, SL, Negro, F, Rubbia-Brandt, L and Giostra, E (2015) Nonalcoholic hepatitis is associated with increased mortality in obese patients undergoing bariatric surgery. Clinical Gastroenterology and Hepatology 14, 1619–1628.CrossRefGoogle Scholar
Griffin, BA, Ramchand, R, Almirall, D, Slaughter, ME, Burgette, LF and McCaffery, DF (2014) Estimating the causal effects of cumulative treatment episodes for adolescents using marginal structural models and inverse probability of treatment weighting. Drug and Alcohol Dependence 136, 69–78.CrossRefGoogle ScholarPubMed
Hirano, K and Imbens, GW (2001) Estimation of causal effects using propensity score weighting: an application to data on right heart catheterization. Health Services and Outcomes Research Methodology 2, 259–278.CrossRefGoogle Scholar
Imbens, GW (2004) Nonparametric estimation of average treatment effects under exogeneity: a review. Review of Economics and Statistics 86, 4–29.CrossRefGoogle Scholar
Imbens, GW and Wooldridge, JM (2009) Recent developments in the econometrics of program evaluation. Journal of Economic Literature 47, 5–86.CrossRefGoogle Scholar
Jabson, JM, Farmer, GW and Bowen, DJ (2015) Health behaviors and self-reported health among cancer survivors by sexual orientation. LGBT Health 2, 41–47.CrossRefGoogle ScholarPubMed
Jena, AB, Goldman, DP and Seabury, SA (2015) Incidence of sexually transmitted infections after human papillomavirus vaccination among adolescent females. JAMA Internal Medicine 175, 617–623.CrossRefGoogle ScholarPubMed
Johnson, CL, Paulose-Ram, R, Ogden, CL, Carroll, MD, Kruszan-Moran, D, Dohrmann, SM and Curtin, LR (2013) National health and nutrition examination survey: analytic guidelines, 1999–2010. Vital and Health Statistics. Series 2, Data evaluation and methods research, 161, 1–24.Google Scholar
Jung, P-S, Kim, D-Y, Lee, S-W, Park, J-Y, Suh, D-S, Kim, J-H, Kim, Y-M, Kim, Y-T and Nam, J-H (2015) Clinical role of adjuvant chemotherapy after radical hysterectomy for FIGO stage IB-IIA cervical cancer: comparison with adjuvant RT/CCRT using inverse-probability-of-treatment weighting. PloS One 10, e0132298.CrossRefGoogle ScholarPubMed
Kaiser, B and Schmid, C (2014) Does physician dispensing increase drug expenditures? Empirical evidence from Switzerland. Health Economics 25, 71–90.CrossRefGoogle ScholarPubMed
Leidner, AJ (2014) Estimating the effectiveness of health-risk communications with propensity-score matching: application to arsenic groundwater contamination in four US locations. Journal of Environmental and Public Health 2014, 1–9, Article ID 783902, http://dx.doi.org/10.1155/2014/783902.CrossRefGoogle ScholarPubMed
Liddon, NC, Leichliter, JS and Markowitz, LE (2012) Human papillomavirus vaccine and sexual behavior among adolescent and young women. American Journal of Preventive Medicine 42, 44–52.CrossRefGoogle ScholarPubMed
Markowitz, LE, Dunne, EF, Saraiya, M, Lawson, HW, Chesson, H and Unger, ER (2007) Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP). Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 56(RR-2), 1–24. PubMed PMID: 17380109.Google Scholar
Markowitz, LE, Hariri, S, Lin, C, Dunne, EF, Steinau, M, McQuillan, G and Unger, ER (2013) Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. Journal of Infectious Diseases 208, 385–393.CrossRefGoogle ScholarPubMed
Markowitz, LE, Dunne, EF, Saraiya, M, Chesson, HW, Robinette Curtis, C, Gee, J, Bocchini, JA Jr and Unger, ER (2014) Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report 63, 1–30.Google Scholar
Markowitz, LE, Liu, G, Hariri, S, Steinau, M, Dunne, EF and Unger, ER (2016) Prevalence of HPV after introduction of the vaccination program in the United States. Pediatrics 137, 1–9 (e20151968).CrossRefGoogle ScholarPubMed
Mayhew, A, Kowalczyk Mullins, TL, Ding, L, Rosenthal, SL, Zimet, GD, Morrow, C and Kahn, JA (2014) Risk perceptions and subsequent sexual behaviors after HPV vaccination in adolescents. Pediatrics 133, 404–411.CrossRefGoogle ScholarPubMed
Meites, E, Kempe, A and Markowitz, LE (2016) Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report 65, 1405–1408.CrossRefGoogle ScholarPubMed
Moghtaderi, A and Dor, A (2016) Immunization and Moral Hazard: The HPV Vaccine and Uptake of Cancer Screening. National Bureau of Economic Research.CrossRefGoogle Scholar
Mullins, TLK, Zimet, GD, Rosenthal, SL, Morrow, C, Ding, L, Shew, M, Dennis Fortenberry, J, Bernstein, DI and Kahn, JA (2012) Adolescent perceptions of risk and need for safer sexual behaviors after first human papillomavirus vaccination. Archives of Pediatrics &Adolescent Medicine 166, 82–88.CrossRefGoogle ScholarPubMed
Murphy, DA, Harrell, L, Fintzy, R, Belin, TR, Gutierrez, A, Vitero, SJ and Shetty, V (2014) A comparison of methamphetamine users to a matched NHANES cohort: propensity score analyses for oral health care and dental service need. The Journal of Behavioral Health Services & Research 43, 676–690.CrossRefGoogle Scholar
Offit, PA (2014) Let's not talk about sex, in New York Times. https://www.nytimes.com/2014/08/20/opinion/lets-not-talk-about-sex-HPV-vaccine.html (August 19, 2014).Google Scholar
O'Halloran, A, Lu, P, Williams, W, Black, C, Singleton, JA (2016) HPV vaccination coverage among women by birth cohort and age, NHIS 2008–2014 [Unpublished data]. Centers for Disease Control and Prevention.Google Scholar
Petrosky, E, Bocchini, JA Jr, Hariri, S, Chesson, H, Robinette Curtis, C, Saraiya, M, Unger, ER and Markowitz, LE (2015) Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report 64, 300–304.Google ScholarPubMed
Rao, J, Wu, C and Yue, K (1992) Some recent work on resampling methods for complex surveys. Survey Methodology 18, 209–217.Google Scholar
Reagan-Steiner, S, Yankey, D, Jeyarajah, J, Elam-Evans, LD, Curtis, CR, MacNeil, J, Markowitz, LE and Singleton, JA (2016) National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2015. Morbidity and Mortality Weekly Report 65, 784–792.Google ScholarPubMed
Ridgeway, G, Kovalchik, SA, Griffin, BA and Kabeto, MU (2015) Propensity score analysis with survey weighted data. Journal of Causal Inference 3, 237–249.CrossRefGoogle ScholarPubMed
Rimer, B, Harper, H and Witte, O (2014) Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer. A Report to the President of the United States from the President's Cancer Panel. Bethesda, MD: National Cancer Institute.Google Scholar
Rolnick, SJ, Parker, ED, Nordin, JD, Hedblom, BD, Wei, F, Kerby, T, Jackson, JM, Crain, AL and Euler, G (2013) Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors? Vaccine 31, 3928–3935.CrossRefGoogle ScholarPubMed
Rose, E, DiClemente, RJ, Wingood, GM, Sales, JD, Latham, TP, Crosby, RA, Zenilman, J, Melendez, J and Hardin, J (2009) The validity of teens’ and young adults’ self-reported condom use. Archives of Pediatrics & Adolescent Medicine 163, 61–64.CrossRefGoogle Scholar
Rosenthal, SL, Weiss, TW, Zimet, GD, Ma, L, Good, MB and Vichnin, MD (2011) Predictors of HPV vaccine uptake among women aged 19–26: importance of a physician's recommendation. Vaccine 29, 890–895.CrossRefGoogle ScholarPubMed
Rubin, DB (1974) Estimating causal effects of treatments in randomized and nonrandomized studies. Journal of Educational Psychology 66, 688–701.CrossRefGoogle Scholar
Satterwhite, CL, Torrone, E, Meites, E, Dunne, EF, Mahajan, R, Bañez Ocfemia, MC, Su, J, Xu, F and Weinstock, H (2013) Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sexually Transmitted Diseases 40, 187–193.CrossRefGoogle ScholarPubMed
Smith, LM, Kaufman, JS, Strumpf, EC and Lévesque, LE (2014) Effect of human papillomavirus (HPV) vaccination on clinical indicators of sexual behaviour among adolescent girls: the Ontario Grade 8 HPV Vaccine Cohort Study. Canadian Medical Association Journal 187, E74–E81.CrossRefGoogle ScholarPubMed
Steiner, RJ, Liddon, N, Swartzendruber, AL, Rasberry, CN and Sales, JM (2016) Long-acting reversible contraception (LARC) and condom use among female US high school students: implications for STI prevention in the context of adolescent LARC scale-up. Journal of Adolescent Health 58, S5–S6.CrossRefGoogle Scholar
Stokley, S, Jeyarajah, J, Yankey, D, Cano, M, Gee, J, Roark, J, Robinette Curtis, C and Markowitz, L (2014) Human papillomavirus vaccination coverage among adolescents, 2007–2013, and post-licensure vaccine safety monitoring, 2006–2014-United States. Morbidity and Mortality Weekly Report 63, 620–624.Google Scholar
Stolte, IG, Dukers, NHTM, Geskus, RB, Coutinho, RA and Wit, JB (2004) Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS (London, England) 18, 303–309.CrossRefGoogle ScholarPubMed
Talih, M (2013) A reference-invariant health disparity index based on Rényi divergence. The Annals of Applied Statistics 7, 1217–1243.CrossRefGoogle ScholarPubMed
Talih, M (2015) Examining socioeconomic health disparities using a rank-dependent Rényi index. The Annals of Applied Statistics 9, 992–1023.CrossRefGoogle ScholarPubMed
Weir, SS, Roddy, RE, Zekeng, L and Ryan, KA (1999) Association between condom use and HIV infection: a randomised study of self reported condom use measures. Journal of Epidemiology & Community Health 53, 417–422.CrossRefGoogle ScholarPubMed
Wooldridge, JM (2009) Estimating average treatment effects: Unconfoundedness, in Lecture notes. BGSE/IZA Course in Microeconometrics.Google Scholar
Supplementary material: File

Leidner et al. supplementary material

Supplementary Appendix

Download Leidner et al. supplementary material(File)
File 84.8 KB